MEDICARE: ANGELA NICHTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26024194A	IN

General Provider Information

NPI Number	:	1720603368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA NICHTER

Provider Business Mailing Address
First Line	:	12507 FRESHWATER TRL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-9163
Country	:	US
Telephone Number	:	219-229-4984
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 SAINT JOE CENTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2506
Country	:	US
Telephone Number	:	260-485-7998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	06/09/2020

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Directions to “ ANGELA NICHTER ” Practice Location

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